- •Cardiotocography
- •Ultrasound examination
- •Self control questions.
- •3.5.2. Self control tests.
- •Gestosis
- •Oligoamnios
- •Anemia
- •Hydramnion
- •1. Recognize factors which determine drug passage across the placenta and into breast milk.
- •2. Identify aspects of medications that determine safety during lactation.
- •• A substance, organism, physical agents or deficiency state capable of inducing abnormal structure or function such as:
- •• Timing of exposure
- •• Developmental stage during exposure
- •• Maternal dose and duration
- •• Maternal pharmacokinetics
- •IV. FDA Pregnancy Categories
- •V. FDA Pregnancy Categories
- •VI. FDA Labeling Changes
- •VII. Drug Transfer to the Fetus
- •VIII. Drug Passage into Breast Milk
- •IX. Drug Transfer
- •XI. Fetal Drug Disposition
- •• 60 – 80% passes through liver, the rest travels through ductus venosus to heart and brain
- •XII. Drug Concentration in Breast Milk
- •XIII. Calculating Drug Exposure
- •Infant dose/maternal dose using mg/kg/d
- •XIV. Neonatal Factors
- •XV. Infant Adverse Effects
- •XVI. Anti-infectives
- •XVII. Penicillins
- •XVIII. Cephalosporins
- •• Category B/C/B in pregnancy
- •XXIII. Sulfonamides
- •XXV. Miscellaneous Antibiotics
- •XXVI. Miscellaneous Antibiotics
- •XXVII. Miscellaneous Antibiotics
- •XXVIII. Miscellaneous Antibiotics
- •Antiretrovirals/NNRTI (delavirdine, efavirenz, nevirapine)
- •Antiretrovirals/PI
- •Antiretrovirals/Fusion Inhibitor (enfuvirtide)
- •Antiretroviral Combinations
- •Antifungals/Echinocandins (anidulofungin, caspofungin, micafungin)
- •Antifungals/Polyenes
- •XXXII. Migraine Headache Therapy
- •Triptans (5-HT1 agonists)
- •Triptans (5-HT1 agonists)
- •Butalbital and Caffeine
- •Dichloralphenazone and Isometheptene (Midrin)
- •Questions to Ask:
- •Questions to Ask:
- •Considerations in Breastfeeding:
- •• Withhold or delay therapy if possible
XVI. Anti-infectives
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Penicillins
Cephalosporins
Carbapenems
Fluoroquinolones
Macrolides
Aminoglycosides
Sulfonamides
Miscellaneous Antibiotics
Antivirals
Antiretrovirals
Antifungals
XVII. Penicillins
•Category B in pregnancy
–Cross the placenta easily and rapidly
–Concentrations equal maternal levels
•Lactation
–Crosses in low concentrations
–Compatible with breastfeeding
XVIII. Cephalosporins
•Category B in pregnancy
–Cross the placenta during pregnancy
–Some reports of increased anomalies with specific cephalosporins (cefaclor, cephalexin, cephradrine)
–Primarily cardiac and oral cleft defects
•Lactation
–Excreted into breastmilk in low concentrations
–Considered compatible with breastfeeding
XIX. Carbapenems
(ertapenem, imipenem, meropenem)
• Category B/C/B in pregnancy
–Likely cross the placenta
–Very little human data
•Lactation
–Excreted into breastmilk in low amounts
–Unknown effects but likely low clinical significance
XX.Fluoroquinolones
(floxins)
•Pregnancy Category C
–Not recommended in pregnancy
–Cartilage damage in animals
–Safer alternatives usually exist
•Lactation
–Excreted into breastmilk
–Limited human data
–AAP says compatible with breastfeeding
XXI. Macrolides
(azithromycin, clarithromycin, erythromycin)
•Pregnancy Categories B/C/B
–Cross the placenta in low amounts
–Limited data with azithromycin and clarithromycin
•Lactation
–Erythromycin compatible
–Others probably compatible
XXII. Aminoglycosides
(amikacin, gentamicin, tobramycin)
•Pregnancy Category C
–Rapidly cross placenta
–Enter amniotic fluid through fetal circulation
•Lactation
–Compatible with breastfeeding
–Not absorbed through GI tract